Form Soc 2287 - In-Home Supportive Services Program State Administrative Review Request Response Letter To Recipient Upholding Provider'S Third Violation

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES PROGRAM
STATE ADMINISTRATIVE REVIEW REQUEST RESPONSE LETTER TO RECIPIENT
UPHOLDING PROVIDER’S THIRD VIOLATION (90-DAY SUSPENSION OF
ELIGIBILITY) FOR EXCEEDING WORKWEEK AND/OR TRAVEL TIME LIMITS
(ADDRESSEE)
COUNTY OF:
Notice Date:
Provider Name:
IHSS Office Address:
IHSS Office Telephone Number:
To: In-Home Supportive Services (IHSS) Recipient
This notice is to inform you that the State Administrative Review Request your provider,
_____________________________________________________________________
filed after the third violation he/she received for the month of ______________ has
been reviewed and the violation is upheld as of the date of this notice. The reason for
this decision is based on our review of the State Administrative Review Request
submitted by your provider. There was not enough evidence to demonstrate that
he/she met the criteria required to work more than his/her workweek agreement allows
for. Your provider will continue to have a third violation because he/she:
Worked more than 40 hours in a workweek for a recipient without the recipient
getting approval from the county when that recipient’s maximum weekly hours are
40 hours or less.
Worked more than a recipient’s maximum weekly hours without the recipient
getting approval from the county which caused your provider to work more
overtime hours in the month than your provider normally would.
Worked more than 66 hours in a workweek when your provider works for more than
one recipient.
Claimed more than 7 hours of travel time in a workweek.
Your provider’s eligibility to provide IHSS services will be suspended 20 calendar days
from the date of this notice, for a period of 90 days.
If you need assistance finding a new provider until your regular provider is eligible to
provide services again, please contact your county IHSS office.
If you are unsure of the date your provider is eligible to be an IHSS provider or have
questions about this notice, please contact your county IHSS office.
SOC 2287 (6/16)

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